Failure to Provide Timely Physician-Ordered Pain Medication
Penalty
Summary
A deficiency occurred when the facility failed to acquire and administer physician-ordered pain medication for a resident admitted with pancreatic adenocarcinoma and other serious conditions, including an upper gastrointestinal bleed and portal vein thrombosis. Upon admission, the resident had orders for Dilaudid and acetaminophen for pain management. Despite these orders, the facility did not ensure the timely procurement and administration of Dilaudid, resulting in the resident experiencing high levels of pain. Documentation showed that the resident repeatedly reported severe pain, with pain scores as high as 10, and that alternative pain medications were either not administered or were ineffective. The clinical record revealed significant delays in the administration of Dilaudid, with the first dose given approximately 35 hours after admission. During this period, the resident received acetaminophen and, at times, Tramadol, but these interventions provided minimal or no relief. There were also instances where pain medications were not available in the facility's Pyxis system, and staff did not consistently document pain assessments or reasons for withholding medication. Communication lapses were evident, as the pharmacy did not receive the required prescription for Dilaudid until several days after admission, and staff did not escalate the issue promptly to supervisors or the DON as required by policy. Interviews with staff indicated confusion regarding procedures for obtaining medications from the Pyxis system and the steps to take when medications were unavailable. Some staff members lacked access to the Pyxis due to their employment status, and there was inconsistency in following the facility's policy for medication procurement and escalation. The failure to provide the ordered pain medication resulted in the resident experiencing unmanaged pain for an extended period, as documented in nursing and progress notes.
Removal Plan
- Education to the licensed nursing staff on the Medication Procurement and Pharmacy Services Policies
- Education on pharmacy notification when medications are not delivered
- If ordered pain medications are unavailable, the nurse will notify the Supervisor
- If unresolved, the issue will be escalated to the DON
- If still unresolved, the Medical Director will be contacted
- Use of the Pyxis for availability of narcotics at admission
- For any resident experiencing unmanaged pain, the nurse will place a call to the physician for alternate orders
- The resident will be provided alternate physician ordered medication to ensure relief until the prescribed narcotic is available